Hearing Loss

Hearing loss is defined as an impaired ability to hear sounds at thresholds considered to be normal. Projections based on audiometric data from the National Health and Nutrition Examination Survey estimate that by 2030, approximately 55 million US adults will have hearing loss, including 35 million with mild loss (25-40 dB) and nearly 20 million with moderate or greater loss (>40 dB).1 The most common cause of hearing loss among hearing aid users is bilateral sensorineural hearing loss due to cochlear hair cell or auditory nerve degeneration. Functional effects of hearing loss differ with severity. Mild hearing loss may affect the ability to understand speech in noisy environments; moderate or greater hearing loss affects the ability to have individual conversations in a quiet room.

Untreated hearing loss is associated with social isolation that can reduce quality of life.2 A meta-analysis of 5 randomized trials (825 adults with mild to moderate hearing loss) that compared those not receiving hearing aids with those who received hearing aids that amplified sounds via air conduction had improved ability to discriminate sound and speech and hearing-related quality of life based on Hearing Handicap Inventory for the Elderly,2 which quantifies self-perceived functional and emotional hearing handicap (such as negative feelings and psychological distress from communication problems). The Hearing Handicap Inventory for the Elderly scores (lower scores indicate less handicap; scale, 0-100) improved by −26.5 (95% CI, −42.2 to −10.8) points with hearing aids, exceeding the minimal clinically important difference of 18.7 points.2

Amplification with hearing aids is the primary treatment for hearing loss, but use is limited. Traditional Medicare does not cover hearing aids, and coverage for associated services remains limited. In a nationally representative cohort using data from the National Health and Aging Trends Study, hearing aid use among US adults aged 71 years and older with hearing loss was 29.2% in 2021, including 14.4% among those with mild loss and 45.3% among those with moderate hearing loss.3 Although reasons for nonuse were not directly assessed, lower-income individuals, along with those who have milder degrees of hearing loss, are less likely to use hearing aids.3 Until recently, hearing aids in the US could only be obtained through licensed hearing care professionals such as audiologists. However, since October 2022, the US Food and Drug Administration has allowed adults to buy hearing aid devices without a medical examination, prescription, or professional fitting. This regulatory change has enabled over-the-counter (OTC) direct-to-consumer hearing aids, with potential to broaden access.

Author/s:

Karina C. De Sousa, De Wet Swanepoel

How useful are direct-to-consumer hearing aids?

Alex Haga — Sun, 11 Aug 2024 18:20:43 +0000

Date Added:

August 11, 2024

Journal/Publication:

Canadian Family Physician

Publication Date:

July 1, 2024

Issue:

7-8

Volume:

Pages:

475

URL:

How useful are direct-to-consumer hearing aids?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.46747/cfp.700708475

Keywords

PMID (1):

39122435

MeSH

Hearing Aids

quality of life

Speech Intelligibility

Hearing Loss

Hearing

Deafness

Information on direct-to-consumer hearing aids for clinicians and patients. James W. Mold, MD, MPH

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Clinical question
Do self-fitted hearing aids improve hearing for adults with mild to moderately severe hearing loss?

Bottom line
Some, not all, direct-to-consumer (DTC) self-fitted hearing aids are likely comparable to audiogram-fitted conventional hearing aids and tend to cost less.

Author/s:

Émélie Braschi, Samantha S Moe

Hearing Loss in Children

Brian Desmarais — Tue, 08 Dec 2020 15:16:05 +0000

Date Added:

December 8, 2020

Journal/Publication:

JAMA Network

Publication Date:

December 1, 2020

Issue:

Volume:

324

Pages:

2195-2205

URL:

Hearing Loss in Children

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2020.17647

MeSH

child

Hearing Loss

Deafness

A review of the causes, consequences, and management of hearing loss in children. James W. Mold, MD, MPH

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Importance Hearing loss in children is common and by age 18 years, affects nearly 1 of every 5 children. Without hearing rehabilitation, hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children.

Observations Consequences of hearing loss in children include worse outcomes in speech, language, education, social functioning, cognitive abilities, and quality of life. Hearing loss can be congenital, delayed onset, or acquired with possible etiologies including congenital infections, genetic causes including syndromic and nonsyndromic etiologies, and trauma, among others. Evaluation of hearing loss must be based on suspected diagnosis, type, laterality and degree of hearing loss, age of onset, and additional variables such as exposure to cranial irradiation. Hearing rehabilitation for children with hearing loss may include use of hearing aids, cochlear implants, bone anchored devices, or use of assistive devices such as frequency modulating systems.

Conclusions and Relevance Hearing loss in children is common, and there has been substantial progress in diagnosis and management of these cases. Early identification of hearing loss and understanding its etiology can assist with prognosis and counseling of families. In addition, awareness of treatment strategies including the many hearing device options, cochlear implant, and assistive devices can help direct management of the patient to optimize outcomes.

Author/s:

Lieu, J.E.C., Kenna, M., Anne, S.

Clinical Practice Guideline: Ménière's Disease Executive Summary

John Bayhi — Mon, 18 May 2020 22:07:40 +0000

Date Added:

May 18, 2020

Journal/Publication:

Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery

Publisher:

Sage Publishing

Publication Date:

April 1, 2020

Issue:

Volume:

162

Pages:

415-434

URL:

Clinical Practice Guideline: Ménière's Disease Executive Summary

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1177/0194599820909439

Keywords

Meniett device

electrocochleography

endolymphatic hydrops

endolymphatic sac decompression

fluctuating aural symptoms

gentamicin

labyrinthectomy

sensorineural hearing loss

sodium-restricted diet

vestibular testing

PMID (1):

32267820

MeSH

A 2020 guideline for diagnosis and management of Meniere’s Disease from the American Academy of Otorhinolaryngology. James W. Mold, MD, MPH

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OBJECTIVE:

Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

PURPOSE:

The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

Author/s:

Basura, GJ, Adams, ME, Monfared, A, Schwartz, SR, Antonelli, PJ, Burkard, R, Bush, ML, Bykowski, J, Colandrea, M, Derebery, J, Kelly, EA, Kerber, KA, Koopman, CF, Kuch, AA, Marcolini, E, McKinnon, BJ, Ruckenstein, MJ, Valenzuela, CV, Vosooney,A, Walsh, SA, Nnacheta, LC, Dhepyasuwan, N, Buchanan, EM

Tinnitus

John Bayhi — Mon, 23 Mar 2020 21:17:31 +0000

Date Added:

March 23, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 16, 2020

URL:

Tinnitus

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2020.0697

Keywords

tinnitus

hearing loss

noise

PMID (1):

32176246

MeSH

A nice review of what we currently know about tinnitus. James W. Mold, MD, MPH

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Tinnitus is an auditory perception in the absence of an auditory stimulus. It may be associated with acoustic trauma (eg, exposure to loud noise), chronic hearing loss, emotional stressors, or spontaneous occurrence. The psychopathological reaction to the perceived auditory stimulus is an enormous source of distress and disability for many patients with tinnitus. National health surveys estimate that nearly 10 in 100 adults experience some form of tinnitus. Among workers exposed to occupational noise, the prevalence of tinnitus is 15 per 100. Of these, tinnitus is burdensome and chronic for roughly 20 million and extreme and debilitating tinnitus for 2 million US residents. Many patients with tinnitus report that the auditory perception impairs sleep, concentration, and cognitive function required for day-to-day functioning. Among the nearly 4.5 million US military veterans receiving service-connected compensation, 42% receive compensation for tinnitus, which makes it the most prevalent service-connected disability. The number of veterans who receive compensation due to tinnitus is nearly 60% greater than the number of veterans who receive compensation for hearing loss, which is the condition with the second most disability claims.

Author/s:

Piccirillo, JF, Rodebaugh, TL, Lenze, EJ

Summary of Revisions: Standards of Medical Care in Diabetes—2020

John Bayhi — Sat, 14 Mar 2020 19:35:38 +0000

Date Added:

March 14, 2020

Journal/Publication:

Diabetes Care

Publisher:

American Diabetes Association

Publication Date:

January 1, 2020

Issue:

Supplement 1

Volume:

Pages:

S4-S6

URL:

Summary of Revisions: Standards of Medical Care in Diabetes—2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.2337/dc20-Srev

Keywords

PMID (1):

31862743

MeSH

Sodium-Glucose Transporter 2 Inhibitors

Diabetic Ketoacidosis

Ficus

Glucagon-Like Peptide-1 Receptor

glycated hemoglobin a

cardiovascular diseases

Consensus

Farmers

Cystic Fibrosis

Transients and Migrants

Pharmaceutical Preparations

depression

Smell

Patient Comfort

electronic nicotine delivery systems

Blood Glucose Self-Monitoring

celiac disease

follow-up studies

Latent Autoimmune Diabetes in Adults

seasons

social determinants of health

Standard of Care

Time-to-Treatment

united states food and drug administration

risk reduction behavior

Centers for Disease Control and Prevention

glucagon-like peptide 1

anxiety disorders

Feeding and Eating Disorders

thyroid diseases

Infections

This is a three-page summary of the 2020 updates to the ADA Guidelines for Type 2 diabetes. James W. Mold, MD, MPH

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No abstract available.

Clinical diagnosis of benign paroxysmal positional vertigo and vestibular neuritis

John Bayhi — Mon, 24 Feb 2020 20:37:12 +0000

Date Added:

February 24, 2020

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Joule Inc

Publication Date:

February 24, 2020

Issue:

Volume:

192

Pages:

E182-E186

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.190334

Keywords

vertigo

benign paroxysmal positional vertigo

MeSH

Benign Paroxysmal Positional Vertigo

A nice review of how to differentiate clinically between benign paroxysmal positional vertigo, vestibular neuritis, and central causes of vertigo.

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KEY POINTS

• Assess patients with vertigo for focal neurologic signs and symptoms, sustained substantial headache or neck pain, inability to stand and spontaneous vertical nystagmus.

• Perform the Dix–Hallpike test only for patients with episodes of vertigo less than 2 minutes and no nystagmus at rest.

• Perform the head impulse, nystagmus and test of skew (HINTS) plus (plus refers to a test of recent hearing loss) examination only for patients with hours or days of constant, ongoing vertigo and nystagmus at rest

Author/s:

Johns, P, Quinn, J